| NPI | 1952759862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019339) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2022-07-22 |